Surgical treatment of cholesteatoma in children.

We retrospectively reviewed patients surgically treated for cholesteatoma to determine the impact of surgical procedures on preoperative hearing status and whether there was preservation, improvement, or deterioration. We reviewed 173 patients treated over a 15-year period. One hundred eighteen (68%) patients had acquired cholesteatoma and 55 (32%) patients had congenital cholesteatoma. One hundred (58%) patients had extensive disease on presentation that required canal wall-down mastoidectomy. Patients with attic cholesteatoma underwent canal wall-up mastoidectomy, and those with cholesteatoma localized to the middle-ear space were adequately treated with tympanotomy. Hearing was preserved in 101 cases (59%), improved in 30 (17%), became worse in 23 (13%), and could not be accurately assessed in 19 (11%) due to lack of documentation. A second surgical procedure for recidivistic (recurrent or residual) disease was required in 53 (30%). Ipsilateral facial paralysis was noted in 3 (1.7%) patients immediately after recovery from anaesthesia, and 1 (0.5%) patient had a sensorineural hearing loss. This study confirmed the aggressiveness of cholesteatoma in children and demonstrated the need for careful preoperative evaluation, meticulous surgical technique, and prudent postoperative follow-up.

Paraseptal structural changes and chronic sinus disease in relation to the deviated septum.

OBJECTIVE: This study was conducted to evaluate the use of computerized tomography in the delineation of the ostiomeatal complex to enhance the endoscopic surgeon's understanding of associated and contributing anatomic features. METHODS: The ostiomeatal complex region (OMC) was prospectively evaluated in 122 consecutive patients as a function of the degree of nasal-septal deviation. This data was correlated with paranasal sinus disease, lateral nasal-wall findings, and middle-turbinate abnormalities. RESULTS: Patients with increasing nasal-septal deviations were associated with a higher incidence of OMC obstruction (p < .05). OMC obstruction in the direction of septal angulation was attributable to nasal septal deformity. However, contralateral OMC obstruction was related to middle-turbinate and lateral nasal-wall abnormalities, which appeared with increased frequency on the side opposite to the septal deviation (p < .05). Furthermore, an increased incidence and severity of sinus disease was noted with increasing septal deviation (p < .05). CONCLUSION: Increasing angles of septal deviation are associated with bilateral sinus disease and contralateral middle turbinate abnormalities and ethmoid bulla prominence.

Management of head and neck lymphatic malformations in children.

Lymphatic malformations (LM) are complex entities. Their development and management remain controversial. A retrospective review of 35 patients treated for lymphatic malformation over a 10-year period (1985-1995) is presented. The demographics of the cases, the method of presentation, treatment modalities, and outcomes are presented. The majority or patients presented at birth, and 83% were treated before the age of 7 years. The most common presentation was an asymptomatic neck mass (74%), of which 54% were in the posterior triangle and 17% were in the submandibular space. The treatment was primarily surgical excision: 22 (63%) patients had total surgical excision, 7 (20%) had partial excision, and 6 (17%) had needle aspiration. A proposal of management is presented.